21st June 2023

Bladder Cancer

Bladder cancer typically presents with haematuria in approximately 80% of cases. Other symptoms include a change in urinary habit (e.g. frequency), dysuria and systemic manifestations including pain and weight loss. Most bladder cancers in the UK are urothelial carcinomas (previously termed transitional cell carcinomas, but this nomenclature is still used in common practice). Squamous cell carcinomas are less common and are typically found in the context of chronic infections.

Bladder cancers are associated with smoking, age, chronic infections, and occupational exposures. The MRCP candidate may realise that questions pertaining to common pathologies focus on the rarer, more interesting aspects of those diseases. So it is wise to remember the occupational exposures, despite their relative rarity, as these will appear in the question stems! These include arylamines, banned for over 50 years in the UK, but exposure is seen in those working in industries dealing with dyes, rubber, and plastics. Polycyclic aromatic hydrocarbons (PAH) exposure may be seen in those working with crude oil or those working nearby sources of combustion (e.g. smelting). Likewise, in parts of the world where schistosomiasis is endemic (e.g. Egypt), squamous cell carcinomas are the most common bladder cancers, so do not ignore information in the stem about the patient’s country of origin.

Treatment for bladder cancer ranges from transurethral resection of bladder tumours (TURBT), intravesical BCG administration (the very same given for TB vaccination), radical cystectomy and radical chemoradiotherapy. Neoadjuvant chemotherapy has an established role to reduce the risk of recurrence prior to radical surgery or chemoradiotherapy (5% 5-year overall survival benefit). Palliative treatments include chemotherapy, immunotherapy, and radiotherapy.